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Global life expectancy reaches new heights but 21 million face premature death this year, warns WHO

Trends towards better health

More people than ever before now have access to at least minimum health care, to safe water supplies and sanitation facilities. Most of the world's children are now immunized against the six major diseases of childhood. The late 20th century has seen overall socioeconomic progress accompanied by steady and sometimes dramatic advances in the control and prevention of diseases, the development of vaccines and medicines, and countless medical and scientific innovations.

Spectacular progress in reducing deaths among children under 5 in the last few decades is projected to continue. There were 21 million such deaths in 1955, about 10 million in 1997, and that figure should decline to 5 million by 2025.

Gaps between the richest and poorest countries remain huge, but are gradually closing, at least in terms of premature deaths. For example, in 1995, 76% of people who died in WHO's African region were under 50. By 2025, the proportion will fall to 57%.

In the European region, only 15% of those who died in 1995 were under 50, and that proportion will fall to just 7% in 2025. The gap between African and European populations in their respective proportion of premature deaths will thus narrow from 61% to 50%.

For developing countries, the good news is that by 2025, infectious diseases such as poliomyelitis, leprosy, guineaworm disease, filariasis and hepatitis B, which together afflict and disable hundreds of millions of people, will have been eliminated or reduced to very low prevalence levels.

In the industrialized world, where population ageing is a major concern, declines in disability from heart disease and some cancers among older people are already evident in a number of countries, largely due to prevention programmes, education and improved treatment.

Technological advances in general, and more progress in medical research, treatment, care and rehabilitation should further enhance quality of life, especially for older people.

The prospect of a healthy and extended old age is becoming a reality for more people than ever, according to the report. They are not only living longer; research shows that in some countries they are also living more healthily, with their rates of disability going down at the same time as their life expectancy goes up.

For example, longterm care surveys in the United States show significant declines in disability prevalence among the aged between 1982 and 1994. Heart disease deaths have been dramatically reduced in Australia, Canada, Finland, France, New Zealand and the United States and some other countries. In Finland, noncommunicable disease prevention programmes in the last 25 years were the main contributory factor in the six extra years of life expectancy gained during that time. In the same period, the number of people in Finland on disability pensions because of cardiovascular disease fell by about 25%.

However, progress has been far from universal. "While health globally has steadily improved over the years, great numbers of people have seen little if any improvement at all." Dr Nakajima says. "The prime concern of the international community must be the plight of those most likely to be left furthest behind as the rest of the world steps confidently into the future.

"These are the many hundreds of millions of men, women and children still trapped in the grimmest poverty. They live mainly in the least developed countries, where the burdens of illhealth, disease and inequality are heaviest, the outlook is bleakest, and life is shortest"

Some gaps in health between rich and poor are at least as wide as they were half a century ago, and are becoming wider still. While people in most countries are living longer, life expectancy is actually decreasing in some others. Between 1975 and 1995, 16 countries with a combined population of 300 million experienced such a decrease. Many of them were African countries.

The report says high death rates among adults under 50 in developing countries are particularly serious because they occur in the working populations upon which poor countries depend to escape from poverty.

In developing countries in 1996, while the proportion of pregnant women receiving antenatal care was 65%, only 40% of live births were delivered in health facilities and only 53% had a skilled attendant at delivery,

Over onethird of the global population lacks access to essential drugs; an average of only 50% of patients take their medicines correctly, and up to 75% of antibiotics are prescribed inappropriately, even in teaching hospitals.